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Bone Complications in Breast Cancer

Posted Aug 24 2008 1:49pm

ANNOUNCER: Breast cancer like many cancers can sometimes spread to other parts of the body. Often the disease attacks the bone and complications occur. Doctors have effective treatments to combat this situation but why do complications occur in the first place?

LEE ROSEN, MD: There are two separate reasons why bone complications would occur in breast cancer. One is that the tumor itself can invade the bone and cause what are almost like holes in the bone. The other is that the cancer itself can cause hormonal or chemical changes that would result in bone loss and the same kinds of symptoms.

GABRIEL HORTOBAGYI, MD: Bone is a very rich depository of substances that enhance the growth of tumor cells, so it's a vicious circle if you wish, during which the tumor cell produces substances that enhance the destruction of normal bone. And the destruction of normal bone ends up in the release of substances that produce growth of cancer cells.

ANNOUNCER: For patients with breast cancer that has spread to the bone, the first symptom is usually pain.

LEE ROSEN, MD: Most of the time patients will come in with symptoms of bone pain or joint aches or something not going right, but routinely we have a way of monitoring for these side effects. We can check people's blood counts. We can use different radiographic examinations like bone scans or CAT scans and make the diagnosis that way.

ANNOUNCER: Breast cancer cells reach the bone through the blood stream. Once there, these cancerous cells can make the disease even more difficult for the patient.

GABRIEL HORTOBAGYI, MD: They can produce a number of complications that include first of all, pain. Second, fractures in areas that are weakened by the destruction of normal bone components. Third, they can release massive amounts of calcium, which complicate our ability to maintain a balance within our blood stream, and can cause in its most extreme form, death. And they can produce other complications that are less common such as compression of the spinal cord.

LEE ROSEN, MD: The bone complications can severely affect people's quality of life. Obviously if someone is in severe pain, or they've had a fracture and they're not able to move in the same way, their lives can be severely affected.

ANNOUNCER: But there are effective treatments available for breast cancer patients with bone complications. Pain medications, radiation therapy and even surgery have proven successful. As have a class of drugs called bisphosphonates.

GABRIEL HORTOBAGYI, MD: What we normally do with patients with bone metastases is number one, to institute the appropriate anticancer therapy. In the case of breast cancer, that is often hormonal therapy. Many other times it is chemotherapy. Second we institute treatment with a group of drugs called bisphosphonates. They can disable the normal bone cells responsible for bone destruction by adding these substances to chemotherapy, or hormone therapy, we can reduce the frequency with which bone complications occur by anywhere from 30-50%.

LEE ROSEN, MD: Until very recently the standard of care in patients with breast cancer was to use pamidronate or Aredia. Now there's a new drug that's called Zometa, and this drug is given over shorter periods of time, 15 minutes intravenously rather than two hours.

We recently completed a very large scale called phase III clinical trial comparing the use of Aredia or Zometa in patients with breast cancer and their bone complications. We showed that the Zometa drug was just as effective as the Aredia and perhaps even more effective though those data still need to mature a little bit for us to understand if one is necessarily better than another.

ANNOUNCER: There is also some data that suggests bisphosphonates might even have anti-tumor effects.

LEE ROSEN, MD: We're not exactly sure of what the bisphosphonates do in terms of controlling the tumor itself. There are some very exciting laboratory date that show, particularly in breast cancer, that the bisphosphonates have an anti-tumor effect and perhaps delay the growth of the tumor or the spread of the tumor, and maybe when they're combined in the laboratory, at least with treatments that are used for breast cancer, they may add to each other, where one plus one can equal three.

ANNOUNCER: There are some side effects with bisphosphonates that occur in a small number of patients.

GABRIEL HORTOBAGYI, MD: The side effects that occur sometimes in a minority of patients might say are low-grade temperature elevation, perhaps transient chills, and occasionally a slight increase in bone pain These effects occur mostly during the first or first and second administration and then they sort of peter out.

ANNOUNCER: By speaking to their physicians about all the current treatments available, bone complications should be one less thing breast cancer patients have to worry about.

GABRIEL HORTOBAGYI, MD: Bone related complications and bone metastases are highly treatable conditions in patients with breast cancer. Most complications can be treated successfully and in many situations they can be avoided or at least delayed until very late in the course of a metastatic disease.

LEE ROSEN, MD: We all recognize that breast cancer has severe impacts on people's quality of life, if not their length of life as well and while we're trying to extend the length of people's lives, we want to make sure that that length of life is accompanied with a good quality of life. If you have a medicine with very few side effects that can be administered very easily, that is very effective, that's a very powerful weapon in the treatment of breast cancer.